1 of 58 WP.11429.2012 IN THE HIGH COURT OF JUDICATURE AT BOMBAY CIVIL APPELLATE JURISDICTION WRIT PETITION NO.11429 OF 2012 (A.S.) Dr.Shalik Bhaurao Ade Petitioner versus 1. Medical Council of India, 2. The Maharashtra Medical Council, 3. The Dean/Principal, Melmaruvathur Adiparasakthi Indsitute of Medical Seiences and Research, Melamaruvathur 603 319 (Tamil Nadu) Respondents WITH WRIT PETITION NO.11431 OF 2012 (A.S.) Dr.Bapat Vishnuprasad Madhusudhan Petitioner versus 1. Medical Council of India, 2. The Maharashtra Medical Council Respondents WITH WRIT PETITION NO.11432 OF 2012 (A.S.) Dr.Asmita Deshmukh Petitioner versus 1. Medical Council of India, 2. The Maharashtra Medical Council, 3. The Dean/Principal, Melmaruvathur Adiparasakthi Indsitute of Medical Seiences and Research, Melamaruvathur 603 319 (Tamil Nadu) Respondents ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
2 of 58 WP.11429.2012 WITH WRIT PETITION NO.562 OF 2013 (O.S.) Dr.Shashikant C. Patel Petitioner versus 1. Medical Council of India, 2. The Maharashtra Medical Council Respondents Mr.Vikram Chavan with Mr.Pavan Patil and Mr.Balaji Barge for Petitioners in WP Nos.11429, 11431 and 11432 of 2012. Mr.M.M.Vashi, Sr.Advocate with Ms.Aparna Deokar, Mr.Makarand Kale, P.Desai, S.M.Sharma i/by M.P.Vashi & Associates for Petitioner in WP No.562 of 2013. Mr.Ganesh Gole for Respondent no.1 Medical Council of India. Mr.Rahul Nerlekar for Respondent no.2 Maharashtra Medical Council. CORAM : S.C.DHARMADHIKARI AND B.P.COLABAWALLA, JJ. DATE OF RESERVING THE JUDGMENT : 27 August 2015 DATE OF PRONOUNCING THE JUDGMENT : 14 October 2015 JUDGMENT (Per : S.C.Dharmadhikari, J.) : In all these petitions, common questions of fact and law are raised and, therefore, they can be disposed of by a common judgment. ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
3 of 58 WP.11429.2012 2. Rule. Rule made returnable forthwith. Respondents waive service. 3. These petitions under Article 226 of the Constitution of India involve a challenge to the orders of Medical Council of India (`MCI') and Maharashtra Medical Council ('MMC') against Petitioners/Doctors for breach of professional code of ethics. 4. We would take the facts in two petitions so that the principal arguments of the learned counsel appearing for the Petitioners and the Respondents can be appreciated. Facts in Writ Petition No.562 of 2014 (O.S.): 5. In Writ Petition No.562 of 2014, the Petitioner Dr.Shashikant Patel is a citizen of India. He is registered as a medical practitioner with Respondent no.2 MMC bearing registration no.47177. The Petitioner was appointed as a Professor of Anatomy by the medical college namely Melmaruvathur Adiparasakthi Institute of Medical Sciences located at Melamaruvathur in the State of Tamil Nadu (`said Medical College' for the sake of brevity). 6. On or about 1 February 2010, the Petitioner took charge as Dean of the said Medical College. An inspection team ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
4 of 58 WP.11429.2012 of MCI carried out an inspection of the said Medical College on 29 March 2010. During this inspection, the inspection team claims to have found 32 declaration forms in respect of 32 faculty members, who were appointed by one Dr.T.Ramesh. It is further claimed by the Respondent no.1 that all the 32 faculty members were practicing Doctors and, therefore, they could not have been shown as full time faculty members. On the inspection report of this team, a complaint was filed with Central Bureau of Investigation (`CBI') at Chennai. The Petitioner in this petition is shown as accused no.7 in the said complaint. The case of the Petitioner is that he had no role absolutely in making appointments of any of these 32 medical practitioners/doctors. Therefore, he gave a statement and recorded by the CBI, that the Petitioner was appointed as an adhoc Dean on 22 January 2010 and took charge on 1 February 2010. The appointment of these 32 doctors was made much prior to the Petitioner's appointment as Dean of the said Medical College. 7. It is in these circumstances that the Petitioner in WP No.562 of 2014 was surprised to be served with an order dated 21 January 2013 passed by MCI the first Respondent in that petition, directing the MMC to remove the name of the Petitioner from the State Medical Register for five years. Annexure A to the petition is a copy of this order. ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
5 of 58 WP.11429.2012 Facts in Writ Petition No.11429 of 2012 (A.S.) : 8. The Petitioner in Writ Petition No.11429 of 2012 filed on the Appellate Side of this Court states that he completed successfully his MBBS course from Grant Medical College, Mumbai in the year 1995. On 26 February 1997, he was registered as a medical practitioner with Respondent no.2 to this petition namely Maharashtra Medical Council. His registration number is MMC 82206. In the year 2000, the Petitioner completed his post graduation in Radio Diagnosis from Grant Medical College itself. He had an excellent academic record and has fared well in all the examinations. During 2001 and 2009, this Petitioner worked as Lecturer/ Associate Professor in various colleges. As there were vacancies to be filled, in the said Medical College in the State of Tamil Nadu, the Petitioner in this petition, approached the said Medical College. It is his claim that pursuant to the application made, he was interviewed by a duly constituted selection committee. He faired well in the interview and bearing in mind his academic record, the Petitioner was appointed as an Assistant Professor in the Department of Radiology at the said Medical College on 1 October 2009. Annexure B to this petition is a copy of the appointment order. 9. The Petitioner then states that he joined the services at the said Medical College and was also allotted quarter for his ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
6 of 58 WP.11429.2012 residence. The Petitioner claims that his appointment was regular and that he was to abide by the teaching schedule prepared by the head of department. The Petitioner states that he conducted regular classes at the said college. In the petition at page 5, the Petitioner refers to a controversy erupted after the allegations of involvement of Dr.Ketan Desai, Ex President of MCI, in corruption cases, particularly about the grant of recognition to medical colleges. On 22 February 2010, Dr.Desai, Ex President of MCI, was arrested by CBI for allegedly accepting a bribe of Rs.2 crores for the grant of recognition to the medical colleges in State of Punjab. He refers to the further action then taken. The Petitioner narrates as to how after this incident, MCI decided to carry out an inspection of several colleges and that is how the inspection team reached the said Medical College in State of Tamil Nadu. The Petitioner states that he was one of the witnesses and cited as such in the complaint made to the CBI post investigation of the said college. The statement of the Petitioner was recorded and at no stage the Petitioner apprehended any disciplinary or other action against him. However, on the basis of his statement to CBI on 12 July 2012, a show cause notice was issued to the Petitioner alleging that the Petitioner has committed professional misconduct by providing false information in the declaration form submitted to MCI during the assessment of the said Medical College. This show cause notice is vague and does not specify as to what was the role of the Petitioner and allegedly during a wrongful and illegal ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
7 of 58 WP.11429.2012 act. The Petitioner was, therefore, surprised when he was called upon to appear before the Ethics Committee of MCI. The Petitioner was questioned about his statement to the CBI but be denied having made a statement and as projected before the said Ethics Committee. The Ethics Committee conducted proceedings in camera. The allegations against the Petitioner are of violation of the provisions of Indian Medical Council Act, 1956 and Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. The Petitioner was also asked to sign a statement already prepared by Respondent no.1. At the same time, the petition proceeds to state that the Petitioner submitted his written statement. 10. Thereafter, the Petitioner came across a news item stating that MCI has removed 25 doctors from its roll. This news item was published on 15 October 2012. Thereafter, the Petitioner took search on the MCI website. The Petitioner states that no report of the Ethics Committee was issued much less served on the Petitioner. The Respondent no.1 has taken unilateral and hasty action without affording proper opportunity to the Petitioner and similarly situate candidates. On downloading of the proceedings of MCI from the website, the Petitioner got information that pursuant to the appearance before the Ethics Committee on 21 August 2012, some minutes had been prepared of that meeting, on the basis of which 25 doctors including the Petitioner have been punished for ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
8 of 58 WP.11429.2012 violating Clauses 1.1.1, 1.1.1.1.2 and 8.1 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. That is how there was a recommendation for punishment by way of disciplinary action. The minutes of Ethics Committee were confirmed in a further meeting held on 22 September 2012. The Petitioners then submit that these documents were placed before the Board of Governors and that Board approved the removal of names of 25 doctors from the register of State Council for a period of five years as per the decision dated 27 September 2012. 11. The order removing the name of the Petitioner in Writ Petition No.11429 of 2012 from the register was neither communicated to him nor was he informed through any source about the same. That is how the Petitioner challenges this action as improper, unjust, illegal and arbitrary. It is submitted that the impugned action has violated the Petitioner's fundamental right to carry on his profession as a medical practitioner/doctor, which is guaranteed by Article 19(1)(g) of the Constitution of India. Annexure D to this writ petition is a copy of the public notice. 12. Since all petitions in this group involve similar controversy that in the first paragraph of this judgment we have observed that common questions of law and fact are raised in these petitions. We, therefore, do not deem it necessary to refer ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
9 of 58 WP.11429.2012 to the facts in other petitions. More so, when the learned counsel appearing in other petitions have adopted the arguments of the Petitioner in Writ Petition No.11429 of 2012. 13. Mr.Chavan, learned Advocate appearing for the Petitioner in Writ Petition No.11429 of 2012 submits that there is a fundamental and basic difference in the scheme of Indian Medical Council Act, 1956 and Maharashtra Medical Council Act, 1965. He would submit that if a Doctor or a medical practitioner is on the roll of the State Medical Council, then it is the State Medical Council alone which has disciplinary jurisdiction over him. Our attention is invited to Section 20A of the Indian Medical Council Act, 1956 as also Sections 21 and 24 thereof. Our attention is then invited to the Maharashtra Medical Council Act, 1965 to submit that as far as said Medical Council is concerned, it has power to enroll the doctors and medical practitioners. Once it has power to so enroll them, logically it is that State Council which must take action. Our attention is invited to Section 24 of Indian Medical Council Act, 1956 to submit that as far as that section is concerned, it sets out that where the name of any person is removed from the State Medical Register on the ground of professional misconduct or any other ground except that he is not possessed of requisite medical qualifications, that he can appeal in the prescribed manner to the Central Government and the Central Government ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
10 of 58 WP.11429.2012 after consulting the MCI, communicate its decision. Such a decision is binding on the State Medical Council. Thus, what is envisaged in this provision is consultative or supervisory role of MCI. It has no power, therefore, even in terms of MCI Rules, 1957 and the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 to take action. 14. Mr.Chavan submits that pertinently, no enquiry was held under Section 21 of the Maharashtra Medical Council Act, 1965. Now, a situation has arisen where the Maharashtra Medical Council Act, 1965 has been given a complete go bye. It has been rendered totally nugatory. In any event and without prejudice to the above submissions, Mr.Chavan would urge that a detailed enquiry was never held. There is no compliance with the principles of natural justice, inasmuch as no opportunity was given to the Petitioner to cross examine any witnesses. The Petitioner has been deprived of a meaningful and fair chance to defend himself. Now, his fate is decided and save and except present petition, there is no remedy available in law for him. 15. In support of his submissions, Mr.Chavan has relied upon Indian Medical Council Act, 1956, the Maharashtra Medical Council Act, 1965, the Maharashtra Medical Council Rules, 1967. Reliance is also placed upon certain documents to show that there was a compliance by the Petitioner of the legal requirements when the appointment order was issued to him. ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
11 of 58 WP.11429.2012 Meaning thereby, there is nothing irregular much less illegal about Petitioner's appointment. 16. Mr.Chavan also placed heavy reliance on an order dated 21 July 2015 passed in two Writ Petitions by the Nagpur Bench of this Court being Writ Petition Nos.4905 of 2014 (Dr. (Ms.)Anuja D/o. Awadh Pandey Vs. The Maharashtra Medical Council, Chinchpokli and another) and 4922 of 2014 (Dr.Sachin Bhaurao Gathe Vs. The Maharashtra Medical Council, Chinchpokli and another). 17. As far as original side Writ Petition No.562 of 2013 is concerned, that was argued by Mr.M.M.Vashi. However, prior thereto, in other three writ petitions on the appellate side, Mr.Patil adopted the arguments of Mr.Chavan for petitioners. 18. As far as Dr.Shashikant Patel's petition is concerned (W.P. 562 of 2013 OS petition), Mr.Vashi, learned Senior Advocate appearing for him, submitted that the entire action is illegal, erroneous and contrary to the principles of natural justice. Mr.Vashi submits that the basic principle of "one who hears must decide" has not been adhered to. Mr.Vashi has taken us through the scheme of Indian Medical Council Act, 1956 to submit that the area and field covered by this Act and Maharashtra Medical Council Act, 1965, as far as registration and enrollment of medical practitioners and disciplinary action ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
12 of 58 WP.11429.2012 against them are concerned, is distinct and separate. The Petitioner Dr.Patel is not on the register of MCI. There is no power conferred in the MCI to take action against him. Mr.Vashi invited our attention to Regulation 8.8 to submit that removal from the State Register cannot be directed by MCI. Mr.Vashi submits that the sequence as set out in the dates and events would denote that the Petitioner took charge as an adhoc Dean on 1 February 2010. The inspection by MCI is dated 29 March 2010. The appointments made by the said Medical College were found to be illegal. The appointments had to be approved but it was stated that the same were never approved. As far as the Petitioner is concerned, he had not counter signed the appointment orders. At best, his signature can be found on the declaration form inasmuch as that could be said to be counter signed. This was a very vital distinction and if the show cause notice dated 13 July 2012 had been perused carefully, it would be possible for the Petitioner to point out all this and in great details. However, the impugned order dated 21 January 2013 was passed, that too without hearing the Petitioner. The adverse material was never disclosed to the Petitioner. Mr.Vashi has highlighted the fact that it is the Ethics Committee before whom the Petitioner appeared. The Board of Governors has never heard the Petitioner. The action, however, has been taken by the Board of Governors and on the basis of the report of the Ethics Committee. The principles of natural justice and fairness demand that a copy of the report of the Ethics Committee ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
13 of 58 WP.11429.2012 should have been furnished to the Petitioner. Even the Board was required to hear the Petitioner. Thus, firstly when the Ethics committee heard the Petitioner, it ought to have passed the decision or order and the Board could not have passed the impugned order. If the Board was the disciplinary or the decision making authority, then that authority or Board should have heard the Petitioner and it was equally obliged to comply with the principles of natural justice. Mr.Vashi has also pointed out that there is no compliance with the legal requirement that a punishment, if any, must be inflicted within six months, but in this case, that has not been done. For all these reasons, he would submit that the impugned order deserves to be quashed and set aside. 19. Mr.Vashi has submitted that the grounds of the writ petition of Dr.Patel and particularly ground nos.7(c), 7(d), 7(e), 7(f), 7(g) and 7(j) relate to violation of principles of natural justice. In support of his contentions, Mr.Vashi has relied upon the judgments of Hon'ble Supreme Court of India in Pradyat Kumar Bose Vs. The Hon'ble the Chief Justice of Calcutta High Court 1 and in Institute of Chartered Accountants of India Vs. L.K.Ratna and others 2. 20. Meeting all these contentions on behalf of Respondent no.1 MCI, Mr.Gole, learned counsel, firstly relied 1 AIR-1956-SC-285 2 AIR-1987-SC-71 ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
14 of 58 WP.11429.2012 upon the detailed affidavit in reply. He next contended that there is no substance in this batch of petitions. The Petitioners are projecting themselves to be innocent and blemishless. However, the position is otherwise. Each of these Petitioners are directly involved in the fraud perpetrated on the public in making bogus appointments. The Petitioners are beneficiaries of such a fraud. It is not open to them to proclaim innocence. Mr.Gole has urged that nothing has been done suddenly and as complained. On the other hand, MCI has pointed out that it is a supreme body. It has both original and appellate jurisdiction. There is absolutely no prejudice caused as it is the MCI which has set up the Ethics Committee. Pertinently, none of the Petitioners questioned the authority, power and jurisdiction of MCI to refer the allegations against the Petitioners to the Ethics Committee. The Ethics Committee issued a notice to appear. These Petitioners received the notice. The Roznama would indicate as to how the Petitioners appeared before the Ethics Committee and participated in the proceedings. The minutes record as to how the Ethics Committee called upon the Petitioners to submit their explanation on the complaint of CBI and received by MCI. They also questioned the Petitioners regarding their statements recorded by CBI and the stand as reflected therein. Apart from all this, MCI's Governing Board took the impugned decision. Mr.Gole has submitted that in the affidavit filed in both the petitions, MCI's role and it's position and status has been duly pointed out. ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
15 of 58 WP.11429.2012 21. Mr.Gole while opposing Writ Petition No.11429 of 2012 submitted that the Petitioner therein submitted a declaration form dated 4 March 2010. That was forwarded to MCI by the college authorities stating that the Petitioner has been working as an Assistant Professor in the Department of Radiology. The declaration form furnished by this Petitioner was verified by the Dean of the said college and counter signed by the Managing Director. They have verified the contents of the declaration form. MCI received a self contained note dated 27 February 2012 from CBI, ACB Chennai providing the details of 32 doctors/teaching faculty of the said college who gave false and misleading information as to their full time appointment as faculty in the college. This letter/note of CBI was placed before the Ethics Committee of MCI. The Ethics Committee is comprised of eminent doctors. The Ethics committee examined this letter/note of CBI in its meeting held on 19 July 2012 and after examining the contents, decided to issue show cause notice to all 32 doctors and the Dean of the said college. The Ethics Committee requested the CBI to furnish the documents relied upon by them in the self contained note. 22. In response to the letter of MCI, CBI forwarded the details of the statements of all the 32 doctors by e mail which revealed that the faculty members were not full timers. They had come only for MCI inspection. They represented ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
16 of 58 WP.11429.2012 themselves as full time faculty of the medical college before MCI inspection team and submitted false declaration forms. A copy of the letter dated 7 August 2012 of CBI to MCI with statement of Petitioner in Writ Petition No.11429 of 2012 is relied upon by Mr.Gole. 23. Mr.Gole submits that the show cause notice dated 12 July 2012 was thus issued calling upon these doctors to appear before the Ethics committee on 21 August 2012. The doctors appeared before the Ethics committee on 21 August 2012. Their statements were recorded and none of the factual details came to be denied by them. It is on all this admitted factual material that the Ethics Committee, after due deliberation and discussion, submitted its findings to the Board of Governors. Thus, the said medical college and these doctors had appeared before MCI inspection team and that is how they obtained a recommendation in their favour so that permission given to the college could be renewed for the academic year 2010 11. The active participation of these doctors and the Dean led the Ethics Committee to confirm its minutes of the meeting held on 21 August 2012 in the subsequent meeting. The Board of Governors acted on these approved minutes of the meeting of the Ethics Committee and accepted the recommendations. That is how the impugned action has been taken. ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
17 of 58 WP.11429.2012 24. Mr.Gole submits that MCI is an expert body which recognizes medical colleges. courses. It approves the educational It is thus an apex and parent body for medical education in the country. Its role is highlighted in the Indian Medical Council Act, 1956. If the standards of medical education and practice are prescribed by MCI and it is empowered to do so in law, then equally for its breach and its violation, MCI can take disciplinary measures and actions. If it finds that for petty financial gains some doctors became part of a systemic breach and violation of Indian Medical council Act, 1956, its Code of Ethics and Regulations, then MCI cannot remain a silent spectator. The standards of medical education and the integrity of the noble profession of doctors and teachers have to be upheld and protected at all costs. That is how the MCI acted and Mr.Gole places heavy reliance upon the decision of High Court of Judicature at Madras in Dr.K.Nedumaran Vs. The Chairman, Ethics Committee, MCI and others 3 dated 8 March 2013. He submitted that similar challenges were negatived. Even the medical college was proceeded against and it was debarred from medical admissions for two academic years viz. 2013 14 and 2014 15. The college has undergone one year of penalty already and for the remaining one year, its proceedings are pending before the Hon'ble Supreme Court of India. 3 Writ Petition No.29090 of 2013 and group ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
18 of 58 WP.11429.2012 25. Mr.Gole, therefore, submits that in power of judicial review, this Court may not interfere with such an action of MCI. 26. For properly appreciating the rival contentions, a reference will have to be made to the Indian Medical Council Act, 1956. This Act is enacted to provide for the reconstitution of the Medical Council of India (`hereinafter referred to as "the Council') and maintenance of a Medical Register for India and for matters connected therewith. The Act applies to the whole of India and the definitions are to be found in Section 2. The definition of the terms `Council' in clause (b) of Section 2, `Indian Medical Register' in clause (d) of Section 2, `Medical Institution' in clause (e) of Section 2 and the term `Medicine' in clause (f) of Section 2 are relevant. There are three more definitions, firstly of the term `Regulation' which appears in clause (i) of Section 2, to mean a regulation made under Section 33 of the Indian Medical Council Act, 1956 (hereinafter referred to as 'IMC Act'), `State Medical Council' is defined in clause (j) of Section 2 and the term "State Medical Register' appearing in clause (k) of Section 2. Both these terms are also relevant for our purpose. Both the definitions are reproduced hereinbelow : "Section.2(j) `State Medical Council' means a medical council constituted under any law for the time being in force in any State regulating the registration of practitioners of medicine. Section 2(k) `State Medical Register' means a register maintained under any law for the time being in force in any State regulating the registration of practitioners of medicine." ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
19 of 58 WP.11429.2012 27. Section 3 of IMC Act deals with the constitution and composition of the Council. Section 3A of IMC Act deals with the power of Central Government to supersede the Council & to constitute a Board of Governors. This provision is introduced by amendments to IMC Act vide Act 32 of 2010 and Act 13 of 2011. These provisions will denote as to how there is a power in the Central Government to constitute a medical council. That consists of the members as mentioned in Section 3(1), clauses (a) to (e) of the IMC Act. Since there is a power of Central Government to supersede the council and constitute a Board of Governors, which at the relevant time was functional in these cases, then, we do not have any hesitation in rejecting the submission of the learned Senior Advocate appearing for Dr.Patel and other Advocates appearing in the other petitions. They were vehemently urging that the power is conferred in the Council and that no Ethics Committee or Board of Governors will be able to take an effective, complete and proper decision. We do not see how once the council is superseded by the Central Government and it has appointed a Board of Governors and entrusted it the same functions as the Council carries on, then, it is effectively the Council itself which is exercising the powers conferred by the IMC Act. In this regard, Section 3A(3) and the sub sections following the same, would indicate that there is conferment of the same power and the entrustment of the same functions in the Board of ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
20 of 58 WP.11429.2012 Governors, as are to be performed by the Council. Section 3B of IMC Act reads as under : "S.3B Certain modifications of the Act. During the period when the Council stands superseded, (a) the provisions of this Act shall be construed as if for the word "Council", the words "Board of Governors" were substituted; (b) the Board of Governors shall (i) exercise the powers and discharge the functions of the Council under this Act and for this purpose, the provisions of this Act shall have effect subject to the modification that references therein to the Council shall be construed as references to the Board of Governors; (ii) grant independently permission for establishment of new medical colleges or opening a new or higher course of study or training or increase in admission capacity in any course of study or training referred to in section 10A or giving the person or college concerned a reasonable opportunity of being heard as provided under section 10A without prior permission of the Central Government under that section, including exercise of the power to finally approve or disapprove the same; and (iii) dispose of the matters pending with the Central Government under section 10A upon receipt of the same from it. 28. There is a power conferred in the Central Government to give directions to the Board of Governors or to the Council. By Sections 4 and 5 of IMC Act, the mode of election of the members of the Indian Medical Council by persons enrolled on any of the State Medical Registers and ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
21 of 58 WP.11429.2012 restrictions on nomination and membership are set out. Section 6 of IMC Act provides for the incorporation of the Council. The term `Incorporation of the Council' is defined to mean that the Council so constituted shall be a body corporate by the name Medical Council of India, having perpetual succession and a common seal with power to acquire and hold property, both movable and immovable, and to contract, and shall by the said name sue and be sued. Sections 7 to 9 of IMC Act set out provisions about term of office of President, Vice President and Members, Meetings of the Council and Officers, Committees and Servants of the Council respectively. By sub section (1) of Section 9 of IMC Act, the Council is empowered to constitute from amongst its members an Executive Committee and such other Committees for general or special purposes, as the Council deems necessary, to carry out the purposes of this Act. Therefore, there is no substance in another contention urged by learned counsel for the Petitioners namely the power to take disciplinary proceedings or action has to be exercised by the Council itself and assumption of such power by the Ethics Committee or delegation of said powers to the Ethics Committee, is not permissible in the scheme of IMC Act. The composition of Executive Committee of the Council is set out in Section 10 of IMC Act and by Section 10A, what is mandated is permission for establishment of new medical college, new course of study. These composite powers conferred in the Council would denote as to how in the field of medical ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
22 of 58 WP.11429.2012 education, the Council is supreme in prescribing courses of study or training. The Council's powers are absolute. The Council has been conferred wide powers and, therefore, following this provision, Sections 10B and 10C would indicate that recognition of medical qualifications and granting permission for establishment and continuation of new medical colleges, are matters within the exclusive domain of the Council. 29. The recognition of medical qualifications granted by the Universities or Medical Institutions in India is an aspect covered by Sections 11 to 13 of IMC Act. Thereafter, by Section 14 of IMC Act, special provisions in certain cases of recognition of medical qualifications granted by medical institutions in countries with which there is no scheme of reciprocity, are dealt with. By Section 15, right of persons possessing qualifications in the schedules to be enrolled is dealt with. Sections 15, 16 and 17 of IMC Act read as under : "S.15. Right of persons possessing qualifications in the Schedules to be enrolled : (1) Subject to the other provisions contained in this Act, the medical qualifications included in the Schedules shall be sufficient qualification for enrollment on any State Medical Register. (2) Save as provided in section 25, no person other than a medical practitioner enrolled on a State Medical Register (a) shall hold office as physician or surgeon or any other office (by whatever designation called) in Government or in any institution maintained by a local or other authority; ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
(b) 23 of 58 WP.11429.2012 shall practice medicine in any State; (c) shall be entitled to sign or authenticate a medical or fitness certificate or any other certificate required by any law to be signed or authenticated by a duly qualified medical practitioner; (d) shall be entitled to give evidence at any inquest or in any court of law as an expert under section 45 of the Indian Evidence Act, 1871 (1 of 1872) on any matter relating to medicine. (3) Any person who acts in contravention of any provision of sub section (2), shall be punished with imprisonment for a term which may extend to one year, or with fine which may extend to one thousand rupees, or with both.) S.16 Power to require information as to courses of study and examinations. Every University or medical institution in India which grants a recognised medical qualification, shall furnish such information as the Council may, from time to time, require as to the courses of study and examinations to be undergone in order to obtain such qualification, as to the ages at which such courses of study and examinations are required to be undergone and such qualification is conferred and generally as to the requisites for obtaining such qualification. S.17 Inspection of examinations. (1) The Committee shall appoint such number of medical inspectors as it may deem requisite to inspect any medical institution, college, hospital or other institution where medical education is given, or to attend any examination held by any University or medical institution for the purpose of recommending to the Central Government recognition of medical qualifications granted by that University or medical institution. (2) The medical inspectors shall not interfere with the conduct of any training or examination, but shall report to the Committee on the adequacy of the standards of medical education including staff, equipment, accommodation,training ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
24 of 58 WP.11429.2012 and other facilities prescribed for giving medical education or on the sufficiency of every examination which they attend. (3) The Committee shall forward a copy of any such report to the University or medical institution concerned, and shall also forward a copy with the remarks of the University or institution thereon, to the Central Government." 30. By Section 18 of IMC Act, the Council may appoint visitors at examinations in respect of any medical institution, college or hospital where medical education is imparted. The role of visitors is to report to the President of the Council on the adequacy of the standards of medical education including staff, equipments, accommodation, training and other facilities prescribed for giving medical education or on the sufficiency of every examination which they attend. By Section 19, mode of withdrawal of recognition is prescribed. Such broad and wide powers are conferred so that the Council can take requisite steps to ensure that quality medical education is imparted; the courses as recognised by the Council and study in medical education is undertaken in terms of the policy and other directives of the Council; that recognition and non recognition of such courses and institutions subserves the legislative intent of conferment of powers on the Council and the IMC Act as a whole. These powers of the Council are coupled with a duty. The functions have to be performed so that the medical education does not go below minimum standards and that under graduate and post graduate medical education is on par with global standards. The Council is both a guardian and watchdog. ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
25 of 58 WP.11429.2012 31. After taking care of these matters, the IMC Act then moves on to empower the Council to prescribe the standards of professional conduct and etiquette and code of ethics for medical practitioners. In that regard, Section 20A reads as under : "S.20A Professional Conduct. (1) The Council may prescribe standards of professional conduct and etiquette and a code of ethics for medical practitioners. (2) Regulations made by the Council under sub section (1) may specify which violations thereof shall constitute infamous conduct in any professional respect, that is to say, professional misconduct, and such provision shall have effect notwithstanding anything contained in any law for the time being in force." A perusal of the same would indicate as to how it is the discretion of the Council to prescribe the standards of professional conduct and etiquette and a code of ethics for medical practitioners. Thus, the Act moves on from imparting medical education, recognizing it and thereafter award and confer degrees through the Universities in prescribed medical courses. From all this to actual medical practice, the standards of professional conduct and etiquette and the code of ethics to be followed, are equally matters within the exclusive jurisdiction and authority of the Council. Once it can frame regulations under sub section (1) of Section 20A, then such regulations can specify that the violations thereof would ::: Uploaded on - 14/10/2015 ::: Downloaded on - 17/10/2015 21:29:46 :::
26 of 58 WP.11429.2012 constitute infamous conduct. These regulations and the specific matters covered thereunder regarding infamous conduct and professional misconduct would override and shall be effective notwithstanding anything contained in any law for the time being in force. Pertinently, neither the position, status, power of the Council in prescribing the standards of medical education and conduct of medical practice is questioned nor the Regulations involved are challenged or impugned in these petitions. Thus, the legality and validity of the Act or the subject Regulations is not challenged by the Petitioners. 32. In the backdrop of such exclusive and wide regulatory, controlling and supervisory powers conferred in the Council, we do not see as to how Mr.Vashi can contend that the regulations and which are invoked and applied to the Petitioners in these cases, will not empower the Council to take note of the complaints and allegations against medical practitioners or medical teachers. The Council's overriding power so as to prescribe standards of professional conduct and etiquette and code of ethics will enable it to ensure that they are not violated. These regulations are serving a laudable purpose. If the standards can be prescribed by the Council, regulations can be framed for that purpose and which regulations may incorporate appropriate clauses and provisions so as to deal with the cases of professional misconduct or infamous conduct, then, notwithstanding anything contained in any law for the
27 of 58 WP.11429.2012 time being in force, the Council can act in terms of Section 20A of the IMC Act so as to deal with the specific instances and particular cases. Pertinently, the application of the Regulations is not questioned but the ambit and scope of its clauses. To our mind, a harmonious reading of these clauses or paras would demonstrate that the Council can as a supreme or apex body proceed against every doctor, medical practitioner and teacher if his/her conduct is infamous or he/she has committed a professional misconduct. The profession of medicine encompasses its practice, teaching and administration. The performance and conduct of a professional must be such as would not only prove his/her skills and competence but must show that he is truly worthy of the respect of students, patients and general public. He must earn it by his exemplary qualities and nobility. Hence, in all capacities the professional is accountable to his peers and the society. 33. Mr.Vashi and Mr.Chavan laid emphasis on Section 21 of IMC Act but that section dealing with the Indian Medical Register would indicate as to how the Council shall cause to maintain in the prescribed manner the register to be known as the Indian Medical Register and which shall contain names of all the persons who are, for the time being, enrolled in any State Medical Register and who possess any recognized medical qualifications. It is the duty of the Registrar of the Council to keep its register and maintain it in accordance with law, revise it
28 of 58 WP.11429.2012 from time to time and such register is deemed to be a public document. Hence, maintaining such a register is not merely a formality. Even the the copies of State Medical Registers are required to be supplied by the concerned Registrars to the Council. Equally, any additions and/or amendments to the State Medical Registers have also to be informed to the Council. Therefore, Council's medical register and entries therein are public documents enabling the Council to even act against such registered medical practitioners operating and functional at the State level and registered in the State Medical Registers. The registration in the Indian Medical Register is a matter dealt with by Section 23 of IMC Act and the Registrar of the Council may, on receipt of the report of the registration of a person in a State Medical Register or on an application made in the prescribed manner by any such person, enter such name in the Indian Medical Register. So long as such person possesses a recognized medical qualification, such registration can be obtained by him. 34. Then comes Section 24 of IMC Act, which reads as under : "S.24 Removal of names from the Indian Medical Register : If the name of any person enrolled on a State Medical Register is removed therefrom in pursuance of any power conferred by or under any law relating to registration of medical practitioners for the time being in force in any State, the
29 of 58 WP.11429.2012 Council shall direct the removal of the name of such person from the Indian Medical Register. (2) Where the name of any person has been removed from a State Medical Register on the ground of professional misconduct or any other ground except that he is not possessed of the requisite medical qualifications or where any application made by the said person for restoration of his name to the State Medical Register has been rejected, he may appeal in the prescribed manner and subject to such conditions including conditions as to the payment of a fee as may be laid down in rules made by the Central Government in this behalf, to the Central Government, whose decision, which shall be given after consulting the Council, shall be binding on the State Government and on the authorities concerned with the preparation of the State Medical Register." A perusal of this provision would indicate that if the name of any person/s enrolled on the State Medical Register is removed therefrom in pursuance of any power conferred by or under any law relating to registration of medical practitioners in force in any State, then the Council shall direct removal of name of such person/s from the Indian Medical Register. Great emphasis has been placed on sub section (2) of Section 24 of IMC Act, but that provision would indicate as to how when the name of a person has been removed from the State Medical Register on the grounds stated in sub section (2) of Section 24 or where any application made by the person for restoration of his name to the State Medical Register has been rejected, he may appeal in the prescribed manner and subject to such conditions including conditions as to the payment of a fee, as may be laid down by the Central Government, and such an appeal lies to the Central Government. However, the removal must be on the ground of
30 of 58 WP.11429.2012 professional misconduct or any other ground, except lack of requisite medical qualifications. We do not see how any assistance can be derived from this provision simply because the appellate power is conferred in the Central Government to interfere on specific grounds against an action of removal of the name of any person from a State Medical Register. Far from assisting the Petitioners before us, it would indicate as to how the Council would act in matters of removal of names from the Indian Medical Register. Apart from possessing a power to remove the name of such a person from the Indian Medical Register, the Council does not interfere with the independent exercise of power by the State Medical Council. However, that does not mean that the Council can take no action when it finds patent violation of the standards of professional conduct, etiquette or code of ethics for medical practitioners prescribed by it. As far as that power is concerned, we have been rightly referred to other sections of IMC Act. We need not refer to other provisions, save and except Section 27 of IMC Act, which gives a privilege to every person enrolled on the Indian Medical Register, to practice as a medical practitioner in any part of India and to recover in due course of law in respect of such practice any expenses, charges in respect of medicaments or other appliances, or any fees to which he may be entitled to. Sections 26 and 28 to 31 of IMC Act need not be referred to. Section 32 of IMC Act confers a power to make rules in the Central Government. Section 33 of IMC Act confers power on
31 of 58 WP.11429.2012 the Council to make regulations, which has to be exercised with the previous sanction of the Central Government. The regulations may provide for, inter alia, standards of professional conduct, etiquette and code of ethics to be observed by the medical practitioners [See Section 33(m)]. 35. By Section 34 of IMC Act, all previous enactments have been repealed. Three Schedules to this Act recognize medical qualifications. First schedule recognizes medical qualifications granted by the Universities or medical institutions in India. Second schedule recognizes medical qualifications granted by medical institutions outside India and the third schedule recognizes medical qualifications granted by medical institutions not included in the first schedule. As far as the subject regulations are concerned, they are known as the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 (hereinafter referred to as "the IMC Regulations). These are made by the Council in exercise of the powers conferred by Section 20A read with Section 33(m) of the IMC Act. They are made with the previous approval of Central Government. The preamble to the IMC Regulations would indicate that they relate to professional conduct, etiquette and ethics for registered medical practitioners. Chapter 1 thereof provides for a declaration by the applicant doctor in prescribed format while making an application for registration as a doctor/ medical practitioner. Chapter 1 deals
32 of 58 WP.11429.2012 with ethics to be observed by the Physicians and its clauses set out duties of physicians in general. Then by Chapter 2, duties of Physicians to their patients are settled. Chapters 3 and 4 of IMC Regulations deal with duties of Physicians in consultation and responsibilities of Physicians to each other respectively. By Chapter 5, duties of Physicians to the public and to the paramedical profession are set out and by Chapter 6, unethical acts are mentioned. Thus, these comprehensive provisions would take care of not only the duties and responsibilities of Physicians but deal with their manner of conduct, etiquette and ethics in general with the patients and obligations qua each other to maintain their dignity. When it comes to misconduct, we have Chapter 7 and the instances set out therein or violations mentioned therein, would constitute professional misconduct on the part of physicians. They render him/her liable for disciplinary action. Punishment and disciplinary action is dealt with by Chapter 8. Clauses 8.1 and 8.2 of Chapter 8 of IMC Regulations would indicate as to how the instances of offences and of professional misconduct which are prescribed in Chapter 7, do not constitute and are not intended to constitute a complete list of the infamous acts which calls for disciplinary action. Clauses 8.1 and 8.2 read as under : " CHAPTER 8 8. Punishment and Disciplinary Action
33 of 58 WP.11429.2012 8.1 It must be clearly understood that the instances of offences and of professional misconduct which are given above do not constitute and are not intended to constitute a complete list of the infamous acts which calls for disciplinary action, and that by issuing this notice the Medical Council of India and or State Medical Councils are in no way precluded from considering and dealing with any other form of professional misconduct on the part of a registered practitioner. Circumstances may and do arise from time to time in relation to which there may occur questions of professional misconduct which do not come within any of these categories. Every care should be taken that the code is not violated in letter or spirit. In such instances as in all others, the Medical Council of India and/or State Medical Councils have to consider and decide upon the facts brought before the Medical Council of India and/or State Medical Councils. 8.2 It is made clear that any complaint with regard to professional misconduct can be brought before the appropriate Medical Council for disciplinary action. Upon receipt of any complaint of professional misconduct, the appropriate Medical Council would hold an enquiry and give opportunity to the registered medical practitioner to be heard in person or by pleader. If the medical practitioner is found to be guilty of committing professional misconduct, the appropriate Medical Council may award such punishment as deemed necessary or may direct the removal altogether or for a specified period, from the register of the name of the delinquent registered practitioner. Deletion from the Register shall be widely publicized in local press as well as in the publications of different Medical Associations/Societies/Bodies." 36. This would indicate as to how despite making comprehensive provisions but finding that instances or cases of professional misconduct are not exhaustive and there could be acts of omission and commission which are termed as infamous and calling for disciplinary action, that the Council or the State